Why doesn’t California have more Latino doctors?

Margarita Martinez knew from a young age that she wanted to become a doctor and care for people like her parents, immigrant farmworkers who don’t speak English. As a child, she was in charge of calling clinics to see if they accepted Medi-Cal, California’s Medicaid program for low-income people, so she and her family could get treatment.

Martinez graduated from medical school in May after years of economic and emotional struggle. While she celebrated her achievements, she could not stop thinking about the barriers that keep more Latino students from entering medicine and how that hurts California’s rapidly growing communities.

Latinos make up 39% of the state’s 39 million residents, the largest single ethnic group. But of 119,905 licensed physicians and surgeons in the state, only 6,272 — 5% — selected a cultural background of “Central American,” “Cuban,” “Mexican,” “Puerto Rican,” “South American,” or “Other Hispanic” on their physician survey, according to the Medical Board of California. In Los Angeles County, where Latinos make up 48% of residents, 6% percent of physicians and surgeons indicated a Hispanic background.

Some doctors simply may choose not to list ethnicity on a form. Nevertheless, advocates for Latino health care access agree there's an urgent need for more Latino doctors who have deep roots in their communities.

“There are research studies that have been published in medical journals that have made the argument for almost 20 years that says a doctor seeing the patient and does not speak the language or know the culture of that patient could be committing malpractice,” said Arnoldo Torres, policy consultant to Community Health Centers.

‘Maybe I don’t belong here’

Martinez went to UCLA as an undergraduate, earning a degree in biochemistry. She received a master’s in biotechnology at CSU, Channel Islands. But once she started medical school at the California University of Science and Medicine (CUSM), she realized she was at a disadvantage. Although this newly accredited medical school in San Bernardino focuses on training disadvantaged students to bring more diversity to medical practice, Martinez was one of only a handful of Latinas in her class. 

"A lot of my peers' parents were doctors, dentists or professionals," she said. "That made me feel like, okay, this is a little harder for me.”

She couldn't afford tutors or other resources to improve grades, making concentrating challenging. She struggled with impostor syndrome.

"There's a lot of psychological distress when you're a minority. Psychologically, you feel like, 'Oh! Maybe I don't belong here. Maybe this isn't for me,'" she recalled. "If you have a lot of food insecurity, financial insecurity, that distracts you from studying, and it makes you perform worse than students who had everything catered to them."

CUSM confirmed that among the 62 graduates in the class of 2022, five women, including Martinez, identified as Latina. There were no Latinos.

Increasing the pool of Latino physicians

Latino physicians are significantly more likely than their non-Latino peers to speak Spanish and practice in underserved communities, said Dr. David Hayes-Bautista, professor of public health and medicine and director of the Center for the Study of Latino Health and Culture at the School of Medicine, UCLA. 

“Now, anyone can learn to speak Spanish and practice in a shortage area.” he said. “But most non-Latino doctors make the decision not to learn Spanish and not to practice in the barrio, but rather to practice in places like Beverly Hills.”

Until 1978, California graduated about one Latino from any given medical school every three to four years, said Hayes-Bautista. Then international medical graduates arrived from Latin America and began to close the physician gap. Unlike other states, however, California closed this “back door” to entering medicine in the United States amid fears there would be too many foreign doctors.

“In California you almost never find a first-year resident who is an international medical graduate in hospitals,” said Hayes-Bautista. “If you go to New York, half of the first-year residents are international medical graduates.”

Torres and the California Hispanic Health Association drafted a bill to allow doctors and dentists from Mexico to practice in nonprofit clinics in a three-year program. In 2002, Gov. Gray Davis signed the bill. But it took two decades to find a medical facility with an approved residency program to offer the doctors an orientation to the California medical system and get the program off the ground. In 2016, Natividad Medical Center in Monterey County agreed to offer the orientation program.  In 2020, the selection of doctors started. From August 2021 to May 2022, 11 Mexican doctors arrived. They serve mainly farmworker communities in rural Central and Northern California.

Programs like this are important, but a state with such a large Latino population should not have to depend on talent from abroad to address the Latino physician shortage. The “California's Latino Physician Crisis” report points out that the shortage reflects deeper failures of the state’s education pipeline from kindergarten through college, and solutions must be integrated with broad education reforms. The report calls for increasing Latino medical school admissions, recruiting Californians who graduated from out-of-state medical schools to practice in the state, and significantly increasing residency slots, especially in primary care and in hospitals and clinics in underserved communities.

Advocating for more Latino doctors

Martinez is doing her residency in internal medicine at Harbor-UCLA Medical Center in Torrance while continuing to advocate for more Latino doctors through the Latinos Medical Student Association chapter she founded at school. In the association, “like-minded Hispanic students work together, coordinate with Hispanic mentors and do outreach work in the community to help students from underserved and minority backgrounds,” she said.

She’s also part of the MiMentor app, a helpful tool for Latinos looking for advice on getting into medical school or help with applications.

Martinez hopes to eventually practice in an underserved area with primarily Spanish-speaking patients.

“I feel like I could really connect with these patients because I also have this background,: she said. “Also, by speaking Spanish, I will be able to provide them with better medical care and explain their medical problems in a way they could actually understand.”

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